INTRODUCTION: New terminologies of metabolic dysfunction-associated steatotic liver disease (MASLD) have been developed. We assessed hepatocellular carcinoma (HCC) risk across MASLD and/or alcohol intake. METHODS: We included participants aged 40–79 years receiving a national health checkup from 2009 to 2010 in the Republic of Korea, classified as follows: non-MASLD, MASLD, MASLD with increased alcohol intake (MetALD; weekly alcohol 210–420 g for male and 140–350 g for female individuals), and alcohol-associated liver disease (ALD; excessive alcohol intake with weekly alcohol ≥420 g for male or ≥350 g for female individuals). The primary outcome was HCC incidence. HCC risk was estimated using multivariable Cox proportional hazard models. RESULTS: Among 6,412,209 participants, proportions of non-MASLD, MASLD, MetALD, and ALD cases were 59.5%, 32.4%, 4.8%, and 3.4%, respectively. During follow-up (median 13.3 years), 27,118 had newly developed HCC. Compared with non-MASLD, the HCC risk increased from MASLD (adjusted hazard ratio [aHR] 1.66, 95% confidence interval [CI] 1.62–1.71) and MetALD (aHR 2.17, 95% CI 2.08–2.27) to ALD (aHR 2.34, 95% CI 2.24–2.45) in a stepwise manner. Furthermore, the older and non-cirrhosis subgroups were more vulnerable to detrimental effects of MASLD and/or alcohol intake, concerning HCC risk. Among the older, female, and cirrhosis subgroups, MetALD poses similar HCC risks as ALD. DISCUSSION: HCC risk increased from MASLD and MetALD to ALD in a stepwise manner, compared with non-MASLD. For an effective primary prevention of HCC, a comprehensive approach should be required to modify both metabolic dysfunction and alcohol intake habit.

Background: This study investigated the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and Kidney Cancer Risk, as the incidence of both diseases gradually increases owing to metabolic health issues. Methods: Participants (aged 20–79) undergoing a national health examination between 2009 and 2010 were monitored for new-onset kidney cancer. The MASLD spectrum was classified as non-MASLD, MASLD, or MASLD with increased alcohol uptake (MetALD). Kidney Cancer Risk associated with the MASLD spectrum was estimated using multivariate Cox proportional hazard models. Age- and sex-stratified analyses were also performed. Results: Among 8,829,510 participants (median follow-up 13.3 years), the proportion of non-MASLD, MASLD, and MetALD was 64.9%, 30.3%, and 4.7%, respectively, with newly developed kidney cancer in 17,555 participants. Kidney cancer was significantly increased with MASLD (adjusted hazard ratio [aHR] 1.51, 95% confidence interval [CI] 1.46–1.56) and MetALD (aHR 1.51, 95% CI 1.42–1.61), compared with the non-MASLD group. Kidney Cancer Risk was the highest among young populations (aHR 1.93, 95% CI 1.77–2.11 for MASLD and aHR 1.91, 95% CI 1.65–2.22 for MetALD), according to stratification analysis. Furthermore, the cumulative relationship between metabolic dysfunction and Kidney Cancer Risk was confirmed across all MASLD spectra. Conclusions: Our study highlights the positive association between MASLD and Kidney Cancer Risk, emphasizing a comprehensive approach to metabolic health. This also serves as a call to devote closer attention to the metabolic health of younger patients.

Background: Self-employment is a significant component of South Korea’s labor force; yet, it remains relatively understudied in the context of occupational safety and health. Owing to different guidelines for health checkup participation among economically active individuals, disparities in health maintenance may occur across varying employment statuses. Objective: This study aims to address such disparities by comparing the risk of all-cause mortality and comorbidities between the self-employed and employee populations in South Korea, using nationwide data. We sought to provide insights relevant to other countries with similar cultural, social, and economic contexts. Methods: This nationwide retrospective study used data from the Korean National Health Insurance Service database. Participants (aged 20‐59 y) who maintained the same insurance type (self-employed or employee insurance) for ≥3 years (at least 2008‐2010) were recruited for this study and monitored until death or December 2021—whichever occurred first. The primary outcome was all-cause mortality. The secondary outcomes were ischemic heart disease, ischemic stroke, cancer, and hospitalization with a mental illness. Age-standardized cumulative incidence rates were estimated through an indirect method involving 5-unit age standardization. A multivariable Cox proportional hazards model was used to estimate the adjusted hazard ratio (HR) and 95% CI for each sex stratum. Subgroup analyses and an analysis of the effect modification of health checkup participation were also performed. Results: A total of 11,652,716 participants were analyzed (follow-up: median 10.92, IQR 10.92-10.92 y; age: median 42, IQR 35-50 y; male: n=7,975,116, 68.44%); all-cause mortality occurred in 1.27% (99,542/7,851,282) of employees and 3.29% (124,963/3,801,434) of self-employed individuals (P<.001). The 10-year cumulative incidence rates of all-cause mortality differed significantly by employment status (1.1% for employees and 2.8% for self-employed individuals; P<.001). The risk of all-cause mortality was significantly higher among the self-employed individuals when compared with that among employees, especially among female individuals, according to the final model (male: adjusted HR 1.44, 95% CI 1.42‐1.45; female: adjusted HR 1.89, 95% CI 1.84‐1.94; P<.001). The risk of the secondary outcomes, except all types of malignancies, was significantly higher among the self-employed individuals (all P values were <.001). According to subgroup analyses, this association was prominent in younger individuals with lower incomes who formed a part of the nonparticipation groups. Furthermore, health checkup participation acted as an effect modifier for the association between employment status and all-cause mortality in both sexes (male: relative excess risk due to interaction [RERI] 0.76, 95% CI 0.74‐0.79; female: RERI 1.13, 95% CI 1.05‐1.21). Conclusions: This study revealed that self-employed individuals face higher risks of all-cause mortality, cardio-cerebrovascular diseases, and mental illnesses when compared to employees. The mortality risk is particularly elevated in younger, lower-income individuals who do not engage in health checkups, with health checkup nonparticipation acting as an effect modifier for this association.

Organizational downsizing may be significantly linked to depressive symptoms, yet research on this impact in Asian contexts is limited. This study investigates the association between downsizing during the COVID-19 pandemic and depressive symptoms across diverse employment statuses. This study used the data from 6th Korean Working Conditions Survey. Depressive symptoms were measured using WHO-5 well-being index with a cut-off of 50. Downsizing was defined as decrease in the number of employees during last three years. Multivariable logistic regression adjusted for socio-demographic and occupational factors was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) for depressive symptoms associated with downsizing, including subgroup analyses. Among 26,247 Korean workers (mean age: 43.4, men: 47.5%), the prevalence of depressive symptoms was 29.5% (n = 7,751), and the proportion of downsizing was 15.2% (n = 3,978). The prevalence of depressive symptoms was significantly higher among the downsizing group (36.7%, n = 1,460) than among the no-downsizing group (28.3%, n = 6,291). The result of logistic regression revealed a significant association between downsizing and depressive symptoms (adjusted OR [95% CI]: 1.39 [1.29–1.50]), particularly pronounced among high socioeconomic status workers. This study underscores the significant association between depressive symptoms and organizational downsizing, especially high vulnerability of socioeconomically advantaged and stable workers. These findings highlight the necessity for targeted mental health support and further longitudinal research to clarify the relationship between employment changes and mental health within the Korean workforce.

Early-onset dementia poses a significant public health challenge, particularly due to its profound impact on working-age individuals (under 65 years). This study investigated the association between job loss and early-onset dementia in middle-aged adults in Republic of Korea. Using National Health Insurance Service data in the Republic of Korea, we analyzed participants aged 45–54 years who were employed by private companies and who underwent health checkups between 2009 and 2010. Early job loss was defined as involuntary unemployment within two years of the 2011 index date. The primary outcome was incident dementia, identified using both International Classification of Diseases-10 (ICD-10) codes and antidementia medication use. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. Subgroup analyses were conducted by age, household income, residential region, company size, and industrial sector. Among 1,130,665 participants (mean age 49.2 ± 2.82 years, follow-up of 14.02 years), early-onset dementia occurred in 3,748 individuals. Of these, 580 cases were from the job loss group (n = 98,504) and 3,168 cases were from the remaining employed group (n = 1,032,161). Job loss was significantly associated with an increased risk of early-onset dementia in both males (adjusted HR: 1.75; 95% confidence interval, 1.57–1.95) and females (adjusted HR: 1.51; 95% confidence interval, 1.27–1.78). Subgroup analyses identified a higher dementia risk among low-income individuals, particularly in males under 50, females over 50, and those employed in the primary industrial sector. Job loss was significantly associated with an increased risk of early-onset dementia, particularly among males, after adjusting for multiple demographic, socioeconomic, and health-related covariates.

Replacement drivers represent a significant portion of platform labor in the Republic of Korea, often facing night shifts and the demands of emotional labor. Research on replacement drivers is limited due to their widespread nature. This study examined the levels of presenteeism and absenteeism among replacement drivers in comparison to those of paid male workers in the Republic of Korea. This study collected data for replacement drivers and used data from the 6th Korean Working Conditions Survey for paid male workers over the age of 20 years. Propensity score matching was performed to balance the differences between paid workers and replacement drivers. Multivariable logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals for presenteeism and absenteeism by replacement drivers. Stratified analysis was conducted for age groups, educational levels, income levels, and working hours. The analysis was adjusted for variables including age, education, income, working hours, working days per week, and working duration. Among the 1,417 participants, the prevalence of presenteeism and absenteeism among replacement drivers was 53.6% (n = 210) and 51.3% (n = 201), respectively. The association of presenteeism and absenteeism (adjusted OR [95% CI] = 8.42 [6.36−11.16] and 20.80 [95% CI = 14.60−29.62], respectively) with replacement drivers being significant, with a prominent association among the young age group, high educational, and medium income levels. The results demonstrated that replacement drivers were more significantly associated with presenteeism and absenteeism than paid workers. Further studies are necessary to establish a strategy to decrease the risk factors among replacement drivers.